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Published online: 6 January 2017
© Springer International Publishing Switzerland 2017
Abstract Stasis dermatitis commonly occurs in older age. It is caused by venous hypertension resulting from retrograde flow due to incompetent venous valves, valve destruction, or obstruction of the venous system. Further tissue changes arise from an inflammatory process mediated by metalloproteinases, which are up-regulated by ferric ion from extravasated red blood cells. Stasis dermatitis presents initially as poorly demarcated erythematous plaques of the lower legs bilaterally, classically involving the medial malleolus. It is one of the spectrum of cutaneous findings that may result from chronic venous insufficiency. Its mimics include cellulitis, contact dermatitis, and pigmented purpuric dermatoses. Duplex ultrasound is useful in demonstrating venous reflux when the clinical diagnosis of stasis dermatitis is inadequate. Conservative treatment involves the use of compression therapy directed at improving ambulatory venous pressure. Interventional therapy currently includes minimally invasive techniques such as endovenous thermal ablation and ultrasound-guided foam sclerotherapy, which have supplanted the use of open surgical techniques.
1 Introduction
As a hallmark of an underlying vascular pathology and possible precursor to venous ulcerations, stasis dermatitis (SD) is an important disease to be familiar with. SD occurs commonly in the elderly, and with the ever-growing geriatric population, SD will become only a more common disease encountered by healthcare providers. Familiarity with the diagnosis and treatments of SD can help prevent complications such as venous ulcers (VUs), which have a considerable impact on healthcare costs and patients.
2 Prevalence and Economic Impact
SD was found in 1.4% of 773 individuals in a study of patients aged >15 years with varicose veins [1, 2]. It occurs more commonly in older age, with a prevalence of 6.2% in a study of 4099 patients aged >65 years [3]. Other studies have shown a prevalence of 6.9% in 584 elderly patients with a mean age of 80 years (range 55-106) and 5.9% in 68 patients with a mean age of 74 years (range 50-91) [4, 5]. SD is one of the advanced cutaneous presentations of chronic venous insufficiency (CVI). An estimated 2-6 million people in the USA have advanced forms of CVI, such as leg swelling and skin changes, and approximately 500,000 have VU [6]. Chronic venous diseases (CVD) have a considerable...